title: Topical negative pressure to treat surgical site infections, with a focus on post-sternotomy infections: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Topical negative pressure (TNP) has become a common treatment of infected wounds. A systematic review and meta-analysis was performed to investigate TNP efficacy compared to conventional therapy in the treatment of deep surgical site infections (SSIs), particularly post-sternotomy infections.
  
  
  METHODS
  MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials were searched for randomized clinical trials (RCTs) and observational studies comparing TNP to conventional treatment in deep SSIs published up to February 2012. Study quality was evaluated through the GRADE system and bias risk through the Newcastle-Ottawa scale (NOS). Primary outcome was infection cure/wound resolution rate. Secondary outcomes were adverse events, length of stay, mortality, and costs. The results are presented with 95 % confidence intervals (95 % CIs) and report estimates as odds ratios (ORs). Heterogeneity was determined through the I (2) test, with >50 % being considered significant.
  
  
  RESULTS
  Among 83 studies retrieved, 12 cohort studies including 873 patients were considered. All the studies were of low quality, 11/12 had a medium risk of bias, and none were RCTs. Wound resolution was obtained more frequently in TNP-treated patients as compared with continuous and closed drainage (OR 6.45, 95 % CI 3.46-12.00). TNP use was associated with significant reduction of length of stay compared with standard of care (mean difference: 8.21, 95 % CI -12.19, -4.23). High heterogeneity was detected between studies, explained by the TNP comparator type.
  
  
  CONCLUSIONS
  The systematic review and meta-analysis suggest that TNP might be more effective than standard therapy in the cure of deep SSIs. However, multicenter RCTs are needed to confirm the potential value of this treatment.
authors.affiliation: Infectious and Tropical Diseases Unit, Istituti Ospitalieri di Cremona, 26100, Cremona, Italy, a.pan@ospedale.cremona.it.
authors.forename: A
authors.initials: A
authors.lastname: Pan
authors.forename: G
authors.initials: G
authors.lastname: De Angelis
authors.forename: E
authors.initials: E
authors.lastname: Nicastri
authors.forename: G
authors.initials: G
authors.lastname: Sganga
authors.forename: E
authors.initials: E
authors.lastname: Tacconelli
mesh_terms: D002986:Clinical Trials as Topic; D006801:Humans; D054843:Negative-Pressure Wound Therapy / Q000379:methods*; D012874:Skin Diseases, Infectious / Q000628:therapy; D018461:Soft Tissue Infections / Q000628:therapy; D056346:Sternotomy / Q000009:adverse effects*; D013530:Surgical Wound Infection / Q000628:therapy*